Impressions of data

[Cam12]

Hi all. New here and grateful to have found a group focused on CPAP. I’ve been using CPAP nightly for 12 years. I continue to have excessive daytime sleepiness and rarely have a refreshing sleep (2-4 nights/year that i feel refreshed). I’m also diagnosed with tough-to-treat PLMD to which I have attributed my ongoing fatigue. I’ve assumed my CPAP has not been an issue as doctor says all looks fine. But, because of continued symptoms, I download Sleepyhead last week to dig deeper into nightly data. I had a really bad night 2 days ago. I had no awakenings but the data graphs look a lot different than the previous nights. I’ve attached screen grabs of the graphs for the entire night (plus a 2.5 hr nap at noon). I’m hoping someone might have some ideas as to why there appears to be consistent changes across graphs that don’t appear to correspond with CA’s or hypopnea. Would appreciate anyone’s impression as to what might be going on. Thanks.

[Cam12]

Two other attachments that may be helpful

[Sleep2Snore]

You are doing not to bad, if you want to try to get it better you might get a few central creeping in.  I would let the machine decide the maximum pressure or at least let it have the freedom to increase to 18, if you see more clearway events appear, try putting the EPR to 3.
To be honest, you are doing not to bad, just keep an eye on the clearway events.
The machine I have is allowed to go to 20 if it wants, but it has never gone above 13 so far.
Unless you have a reason to restrict it I would let it decide the max pressure.
I think in your case it might rise slightly to clear an obstructive apnea then then drop down again.
I don't think it will rise much.  Do keep an eye on the clearway events.

[Sleep2Snore]

Try your EPR on 3 to see what happens, this often helps.
You are doing quite well, but try adjusting the EPR to see if that changes the CA's you are having.

I expect someone else will have other ideas.

[Gideon]

I'm going to be other opinions here today.

First your numbers are extremely good. Even better than what they have said. BUT

The flow chart looks very rough and ragged to me it should look solid and smooth at this scale.  Your volume charts are pulsing where they should be fairly even.

I would like to see a few 2 minute segments of your flow chart.

My initial impression is that you should be seeing a pulmonologist.



Show him these charts plus the 2 minute segments I suggested.
 I doubt very much if what I am seeing is apnea related.  Your breathing is looking distressed to me but I am neither a Dr nor a specialist in that area.

I suspect you do have apnea because you are here but that is very well treated.

I would try increasing your EPR to 3 and increasing your minimum by 2 which is 1 more than the EPR increase.

I would not be surprised if a BiPAP or ASV is in you future to manage your breathing.  I would have suggested an EPR of 4 but your machine is not capable of that. 4 falls into the BiPPP range such as the VAuto.

Again IMHO you need to see a pulmonologist

Fred

[Walla Walla]

You have periods of flow limitations that could be positional. You might want to try a soft cervical collar to prevent your chin dropping and cutting off your windpipe. If it is positional the collar should also allow you to reduce your maximum pressures also.

[Cam12]

You are doing not to bad, if you want to try to get it better you might get a few central creeping in.  I would let the machine decide the maximum pressure or at least let it have the freedom to increase to 18, if you see more clearway events appear, try putting the EPR to 3.
To be honest, you are doing not to bad, just keep an eye on the clearway events.
The machine I have is allowed to go to 20 if it wants, but it has never gone above 13 so far.
Unless you have a reason to restrict it I would let it decide the max pressure.
I think in your case it might rise slightly to clear an obstructive apnea then then drop down again.
I don't think it will rise much.  Do keep an eye on the clearway events.

Hi and thanks. Will try the EPR at 3. Are you saying that increasing the max pressure may increase central and/or Clearway events?

[Cam12]

I'm going to be other opinions here today.

First your numbers are extremely good. Even better than what they have said. BUT

The flow chart looks very rough and ragged to me it should look solid and smooth at this scale.  Your volume charts are pulsing where they should be fairly even.

I would like to see a few 2 minute segments of your flow chart.

My initial impression is that you should be seeing a pulmonologist.



Show him these charts plus the 2 minute segments I suggested.
 I doubt very much if what I am seeing is apnea related.  Your breathing is looking distressed to me but I am neither a Dr nor a specialist in that area.

I suspect you do have apnea because you are here but that is very well treated.

I would try increasing your EPR to 3 and increasing your minimum by 2 which is 1 more than the EPR increase.

I would not be surprised if a BiPAP or ASV is in you future to manage your breathing.  I would have suggested an EPR of 4 but your machine is not capable of that. 4 falls into the BiPPP range such as the VAuto.

Again IMHO you need to see a pulmonologist

Fred

Thanks very much for your thoughtful response Fred. Sorry for the delay....havent been feeling very good. Will try your suggestion re: EPR and minimum. Will also speak to my sleep specialist re: seeing a pulmonologist. Here are 5 min and 30 min segments from same night. The pattern is pretty consistent nightly. Not many events but ragged charts. Would appreciate and further insights, suggestions and concerns. Thanks again.

[Cam12]

Thanks, I’ve recently elevated the head of my bed (trying anything at this point) so that may be resulting in a dropped chin. Will give it a try.

[Gideon]

We would like to see these charts

• Event Flags
  
  
• Flow Rate
  
  
• Pressure
  
  
• Leak Rate
  
  
• Snore
  
  
• Flow Limit 
  

To fit all of these on one page shrink each chart a bit by grabbing and dragging an upper or lower edge. The Flow Limit, Snore and Leak Rate charts can be shrunk mor than the others.

Events (OA, H), Snores, and Flow Limits are what the Autoset responds to.

Turn Off The Calendar, Pie Chart and Side-Bar
There is a monthly calendar in the left column, as well as a Pie Chart, both of which are not needed, and hide more valuable information. Also, there is a right side-bar that makes the size of the charts smaller. 

• Turn Off The Calendar, To turn off the monthly calendar, click the triangle in the date line
  
  
• Turn Off The Pie Chart, To turn off the Pie Chart, click on the menu File/Preferences/Appearance, and un-check the box for "Show Event Breakdown Pie Chart".
  
  
• Turn Off Right Side-Bar, Just use the F10 button or the menu View, and uncheck the right sidebar.
  

Also provide from this same format a couple of detailed zoomed views.